A rare case of pneumatosis cystoides intestinalis with bowel perforation and secondary sepsis


COD: 25_10_2021_3572_EP-1 Categorie: , ,

Fulvio Manzi, Gabriele D’Amata, Gaetano Florio, Martino Demoro, Fabio Antonellis, Luca Musmeci, Sergio Santella, Andrea Giannetti, Mauro Del Papa

Ann Ital Chir, 2021; 10 – Oct. 25

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A rare case of pneumatosis cystoides intestinalis with bowel perforation and secondary sepsis

MATERIALS AND METHODS: We present here the case of an 83 y.o. male with intestinal perforation from pneumatosis
cystoides intestinalis and consequent sepsis.
RESULTS: The patient underwent urgency intestinal resection in our institute, with complete restitution ad integrum
Discussion: Pneumatosis cystoides intestinalis is a rare affection, which can be categorized as primary (15%) or idiopathic(
85%). The clinical appearance can be very variable from patient to patient, since it can be completely asymptomatic
or start with life-threatening clinical presentation of bowel perforation and sepsis. There are various theories about
the formation of the gas bubbles trough the intestinal wall. The mechanical theory assumes that the gas, tearing trough
the intestinal wall seeps trough it. The bacterial theory assumes that antibiotic treatment, such as with metronidazole,
allows the creation of gas by microbiological elements like Clostridium Perfringens or Clostridium Difficile. The pulmonary
theory, instead, assumes that air released from ruptured alveoli gets into the mediastinum and retro peritoneum,
reaching the intestinal tract. The treatment is conservative most of the times, except for the cases of intestinal perforation
and sepsis.
CONCLUSIONS: Despite of the long history of the disease, with the first description in 1783, little is known nowadays
about PCI, due to the rarity of symptomatic disease. Further studies are needed to better evaluate the aetiology of the
condition, and the prognostic criteria, which may be very important for clinical decisions about conservative or surgical